Management/Leadership Styles

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What are some challenges faced by physicians in their attempts to "lead" colleagues toward a common vision of healthcare performance?

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In any business or organization, leadership is an important component of achieving success.  In the specific area of health care, it is especially important.  The stakes of failure resulting from a dysfunctional work environment can literally mean the death of customers.  Certain professions, law, for instance, involve concentrations of highly-educated individuals who are usually not lacking in self-esteem and who generally hold strong opinions regarding the manner in which they perform their work.  In no profession is the problem of managing or leading -- and the two may overlap, but are not necessarily the same thing -- disparate personalities involved in high-stakes endeavors more challenging than in the field of health care.

One of the biggest problems in leading in the health care environment involves the high levels of self-esteem prevalent among a group of trained practitioners.  And the problem is especially acute in the case of narcissistic physicians with large but easily-bruised egos.  The constant pressures associated with medical care, especially in a hospital, create serious challenges for organizational leadership.  A recent study of the role of ego in the medical profession begins with the observation that 

"A healthy ego is an important part of overall psychological resilience.  However, when faced with an ego threat, individuals with high but unstable self-esteem may be prone to maladaptive behavior aimed at bolstering or safeguarding their self-image." ["Brief Report: Physician Narcissism, Ego Threats, and Confidence in the Face of Uncertainty," Journal of Applied Social Psychology, 2010, 40, 4]

For individuals who have endured the protracted and mentally and physically grueling process of attaining a medical eduation, including internships and residency requirements, the notion of being "led" occasionally does not sit well.  Physicians and nurses come from disparate backgrounds, and while the fundamentals of medical care are consistent across state lines, the cultures of various academic institutions and hospitals are sufficiently different to create tremendous diversity among staffs.

In addition to the problem of dealing with physician ego -- or, more precisely, extending from that challenge -- is the natural resistance of people to organizational change.  Many individuals do not respond well to changes in the practices in which they are experienced and comfortable.  Health care, however, is a dynamic profession in which administrative and practical evolution or change is an integral component of the system.  Leading a staff toward a changed operating environment can be difficult, but necessary in many instances.  A leader's ability to communicate effectively is essential if the challenge of confronting change is to be adequately met.

With the scale of change currently occurring in the field of health care, the imperative of leading one's staff through the transitions on the horizon cannot be overemphasized.  

A perennial challenge for managers or leaders in the field of health care is the need to remain current on developments in health care.  While that may sound obvious and elementary, in practice it is neither.  Administering a medical clinic or hospital is an incredibly demanding job, with the highest of stakes.  Doing so while retaining one's profiency in the practice of medicine can prove daunting.  It is, however, essential if effective leadership is possible when managing a team of practicing physicians.

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